By completing this form you are supplying Equine Ability with personal information about yourself. This information is needed to ensure your safety duringyour time with us. The Provider is required to collect this information by our insurance company and by the department of Workplace Health and Safety.This information you provide will not be supplied to any other organisation or used for any other purpose than insurance and medical assistance.

Full Name
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First Name Last Name

Address
*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Phone number
*

Over 18

yes

Age if under 18 (you will be emailed a separate parental consent form)

E-mail
*

example@example.com

Emergency Contact name
*

Emergency Contact number
*

I am applying to ride with Equine Ability.

I agree to the following:

1) I will only ride the horse in a safe and controlled manner;2) I will wear an Australian Standard Approved Helmet and the correct footwear at all times; 3) I will read and follow all signs on the property and follow all instructions 4) The instructor/ guide may cancel my ride without refunding any fee if I do not comply with any of these terms and conditions

Tetanus Immunisation It is particularly important that people dealing with horse are immunised against Tentanus. Tentanus is normally given at five years of age as Triple antigen or CDT and at fifteen years of age as ADT.

Year of last Tetanus Immunisation (leave blank if unsure)

Is it necessary for you (or your child) to carry their own medication at all times? If so please add name of drug, dosage and frequency:

I consent to medical attention and authorise the instructor in charge to administer first aid and call and ambulance. I agree to bear any cost thereby incurred.
*

Yes

Dietary requirements

Risk Warning & Waiver

Your participation in the recreational activities supplied by Equine Ability (SUPPLIER) may involve risk. The risks involved may result in personal injury including death. Prior to undertaking any such recreational activity, you should ensure you are aware of all of the risks involved, including those risks associated with any health condition you may have.

By signing below, you acknowledge, agree, and understand that participation in the recreational services provided by SUPPLIER may involve risk. You agree and undertake any such risk voluntarily and at your own risk. You also acknowledge that the risk warning above consitutes a 'risk warning' in accordance with the Civil Liability Act 2002 (NSW).

Exclusion, restriction or modification of rights under the Australian Consumer Law (Commonwealth)

Under the Australian Consumer Law (Cth), statutory guarantees apply to the supply of certain goods and services, including recreational activities. It is possible for a supplier to ask you to agree that these statutory guarantees do not apply to you. If you sign this form, you will be agreeing that your rights to sue the supplier because services provided were not in accordance with the guarantees are excluded, restricted or modified as set out below.

By signing below, you agree that the liability of SUPPLIER for any harm including:

• death; • physical or mental injury (including the aggravation, acceleration or recurrence of such an injury); • the contraction, aggravation or acceleration of a disease; • the coming into existence, the aggravation, acceleration or recurrence of any other condition, circumstance, occurrence, activity, form of behaviour, course of conduct or state of affairs:

that is or may be harmful or disadvantageous to you or the community,

that may result in harm or disadvantage to you or the community,

that may be suffered by you (or a person for whom or on whose behalf you are acquiring the services) resulting from the supply of recreational services is excluded.

To the extent that the Competition and Consumer Act 2010 (Cth) applies this exclusion does not apply to significant personal injury caused by reckless conduct of SUPPLIER

Signature of rider/ Signature of Legal Guardian (if participant is under 18)
*